Sunday, September 04, 2005

Besides other communicables, I am beginning to think about antibiotic resistant staph infections. I understand that it has been on the upswing throughout the US and this seems to be a great place for it start running through the community. Any doctors or microbio's who have dependable information on this, please post here.

17 Comments:

A friend and I are driving over to Mississippi from Pensacola tomorrow. We have a surburban full of items from food, water, gatoraide, dog food, lysol, blankets, etc. Too many things to name. The vehicle is packed full (with barely a place to sit). Where should we take these items? Would like to see it go to the people in your community. Any info on where to take these items would be great. Thanks!

I'm a Nurse practitioner; re., MRSA, it could potentially be a very big concern. The CDC has some important instructions:Here's the CDC's advice on how to fight MRSA:

Cover skin infections -- especially those that carry pus -- with clean, dry bandages. Pus from skin infections and infected wounds spread staph to other people. If you have a skin infection or infected wound, tell your family and other close contacts to wash their hands often with soap and warm water. Remember to wash properly: Scrub your hands and fingers while saying the alphabet slowly. Don't stop until you get to Z. Don't let anyone else share any personal items -- including towels, washcloths, razors, or clothing -- that may have come into contact with your infection. Wash bed linens, towels, and clothing in hot water and laundry detergent. Dry these items in a hot dryer, not on the clothesline. If you have MSRA, tell any doctor who treats you that you have an antibiotic-resistant infection. If your doctor gives you antibiotics for a skin infection, be alert for signs of treatment failure. If you get any new boils, sores, or new infections, call your doctor. If your fever gets worse -- or if you get a new fever -- call your doctor. If your infection doesn't look a little better after three or four days, call your doctor. Remember to take all your medicine as prescribed, even if you seem to be better. The germs you leave alive today are tomorrow's drug-resistant bugs.

Now how are poeple in the Astrodome supposed to follow these instrucitons?This is why I would like to go down there and help out.

MRSA, or "multidrug-resistant Staphylococcus aureus" has been a major problem in hospitals, and you're right, it has been on the upswing throughout the US.

This is for several reasons. One, bacteria reproduce much faster than people (under optimal conditions, some bugs can divide as fast as one cell division every ten minutes). With each cell division, the bacteria can acquire mutations, some of which can confer resistance to a particular drug. Two, in addition to their regular chromosome, bacteria have smaller genetic elements called plasmids, that often contain antibiotic resistance genes. Three, these plasmids can be swapped back and forth between bacteria (even between bacterial species), either by taking up plasmids from the environment or by bacterial conjugation, which is the closest thing to bacterial "sex". Also, there are viruses called phage which infect bacteria, and can also carry antibiotic resistance genes from one bacterium to another in their infectious life cycle.

In your environment, where there's a lot of untreated water contaminated with raw sewage and other sources of infectious bacteria (like the chicken and shrimp I read about on your blog earlier), this creates a stew for bacteria to contact one another and swap genes. Additionally, if there's chemicals in this water that are harmful to bacteria, but at levels which are not lethal to them, this creates what is known as a "selection pressure"...it selects for bacteria that are more resistant. This is Darwin's "survival of the fittest" theory in practice. In the lab, we use this all the time to select bugs with specific traits to study. Unfortunately for you, this means that in your water supply, there is a lot of bacteria which could be developing antibiotic resistance and sharing the genes which confer that with their prokaryotic brethren.

Widespread use of antibiotics in hospitals (and incorrect use of antibiotics by people who have been prescribed them...ie: not finishing your prescription when the symptoms go away) has resulted in strains of Staph and other bacterial species that are resistant to every known antibiotic at our disposal. These infections are mainly a problem at hospitals, where ironically patients are often exposed to far more pathogens than elsewhere. In your environment, I wouldn't worry as much about MRSA or antibiotic resistance unless there is an outbreak of it.

Yesterday Rachel told me that you and Josh had been observing people with "sores." This could mean a lot of things, but I would wager that without access to proper hygiene, people who got skin injuries (cuts, lacerations, puncture wounds, etc.) in the storm are having problems with infection. This is not surprising, because any open wound is a potential conduit for infection. Staph and Strep are VERY common bacteria in the environment, and both can also cause skin diseases (boils and impetigo, as well as the VERY RARE necrotizing fascitis, or "flesh-eating" infections). These are usually readily treated with antibiotics, although drug-resistance is becoming a problem.

In any case, it's important to get these skin infections looked at by whatever medical personnel you have access to are available. Regardless of drug-resistance, the best way to get this kind of infection cleared up is to treat it RAPIDLY. As I mentioned before, drug-resistance develops when bacteria are exposed to sublethal levels of antibiotics or antimicrobials. Rapidly treating an infection with the proper antibiotic can kill bugs before they have a chance to develop resistance and pass that gene along to all their friends. Furthermore, getting a condition properly diagnosed and treating it with the right kind of antibiotic will reduce development of resistance to multiple drugs.

In your situation, I would definitely worry about Staph and Strep infections of the skin because these bugs are so ubiquitous in the environment. These can be prevented by cleaning wounds thoroughly WITH SOAP and (preferably boiled or iodinated) water, and then disinfecting with 70% isopropyl alcohol (rubbing alcohol) from the drugstore. Hydrogen peroxide or high-percentage booze (greater than 140 proof) should also work.

In your situation, I would be more concerned about preventing dysentery, cholera, and other diarrheal diseases, mainly because they have the ability to spread so quickly in areas where the sanitation is poor, and because your access to drinking water is limited. Diarrheal diseases can be much more dangerous becaue they can cause severe dehydration very quickly, and in conditions without adequate sanitation, also spread EXTREMELY rapidly. Wash your hands with soap as often as possible, even before you eat or drink. If your hands are contaminated, you can get sick by biting your nails, smoking a cigarette, or anything that will bring these bugs in contact with your mouth.

Also, I understand you have been having a problem with mosquitoes (although that may be more in New Orleans due to all the standing water there). I know that bug-repellant is probably in short supply, but try to apply repellant containing DEET if possible. Mosquitoes can transmit a number of diseases, including West Nile virus, La Crosse encephalitis, St. Louis encephalitis, and malaria, among others. While I don't think that malaria will be much of a problem since this disease has been largely eliminated from the U.S. since the 19th century, elderly people, sick people, and children especially are more at risk for some of these viral diseases. Try to control your exposure to mosquitoes as much as possible.

VERY long story short, drug-resistance or no, limiting your exposure to these pathogens is the best way to prevent it.

I am not a clinical microbiologist, and much of what I have written here is based on my knowledge of the biology of these organisms. I have never treated patients, though, or worked in a clinical setting. I am also not an epidemiologist. Hopefully, someone with more experience in clinical medicine and public health can contribute additional information which will be useful.

As always, I will continue to help in whatever way I can. Any other microbiology questions, holler at your girl. In the meantime, since I'm in virology and bacteria aren't my expertise, I'll ask some of the bacteria people around the department if they have anything else to contribute.

Take care of yourselves, and each other (sorry to quote Jerry Springer, but the sentiment seems appropriate).

Hi... I'm a journalist in Lansing, Mich., and my newsroom has been wondering how all you media guys down there are holding out. I'd like to get a care package to you, if that's possible. If so, where would we send it to and what do you need? You can leave a reply here or contact me at bawieland @ yahoo . com (remove spaces)

Guys, This is the most amazing use of blogging, powerful and emotional stuff. I only get what the tv crews are telling us, it is good (awful) to read what it is really like. Chins up boys. Time for heroes.

Great blog. I am so saddened by this tragedy, and just pray for all of the victims. We will survive as a Country, if we ban together. I have written some pieces about the tragedy of Katrina attalkpoliticswithljp.blogger.com

I'm putting you, and your partner, and all the folks you two come in contact with, in a cloud of silver/golden protective light of the Holy Spirit. You may not believe in this sort of stuff, but I do and my faith can make it happen. (I'm a very old lady who has seen the power of prayer in my life.) Thank you for making all the misery and love real and close for me. What an excellent blog.

Tetanus is less likely to be a problem, since most people are vaccinated against it every 10 years (or should be). Also, tetanus is caused by a toxin produced by the bacterium Clostridium tetani, which is anaerobic, meaning it only grows in environments without oxygen. In order to be exposed to the bacteria in a way that may cause tetanus, you usually need to get a puncture wound that will place the bacteria deep enough in the muscle that it won't be exposed to oxygen. I would definitely worry less about tetanus than some of the other diseases I mentioned in previous posts.

However, people who have sustained deep puncture wounds should be sure to tell any medical staff they encounter about that.